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Which birth control now?

July 4, 2011

My first visit to the OB/GYN after I gave birth was so anticlimatic. I wanted to talk about the labor and all its details, but my OB/GYN was only interested in asking “what are you going to use for birth control?” I had been out of the market for birth control for so long that I had no idea that “the pill” was no longer the standard option. “The ring”, IUDs, “implantables” and “the patch” seem to have taken over.

My biggest disappointment was that my OB/GYN just told me the options, without a lot of information. Anyone else have that experience? I needed a lot more information to make a decision, so I turned to the internet. An article in Parenting Magazine called, A Mom’s Guide to Birth Control by Dana Sullivann was helpful. I wanted to post some excerpts here.

Maybe some of you will have suggestions as to what has worked for you?

I’ve always been on the Pill, but now I’m breastfeeding. That means I can’t go back on it, right?

Not necessarily. The main thing to avoid is contraceptives that contain estrogen, which can reduce your milk supply. So women who are exclusively breastfeeding need to steer clear of birth-control pills that contain both estrogen and progestin, as well as the Patch (a bandagelike square that delivers hormones into your bloodstream) and the Ring (which you insert into your vagina, where it releases hormones).

Instead, you could use a “mini-Pill” — a progestin-only contraceptive, such as Micronor, that won’t affect milk supply. (One caveat: It’s important to take the mini-Pill at the same time every day for optimal effectiveness.)

You can also safely use an intrauterine contraceptive (IUC) or try any barrier method, such as a diaphragm, cervical cap, sponge, condom, and Leah’s Shield (a reusable rubber insert), says Karen Meckstroth, M.D., assistant clinical professor of obstetrics and gynecology at the University of California, San Francisco.

I’m not sure whether I’m done having babies, so what’s long-term but not permanent?

An IUC is ideal, and there are two types. The first, the Mirena IUC, releases a steady stream of progestin and is the most popular birth control with female ob-gyns.

It’s even more effective than tubal ligation if it stays in place, says Dr. Meckstroth. It most likely works by changing the texture of cervical mucus so that it blocks sperm from reaching the eggs. It can also prevent ovulation. It’s approved for up to five years, and once it’s removed you can get pregnant right away.

There’s also ParaGard, an IUC that’s approved for up to ten years and doesn’t use hormones. It releases copper instead, which experts think creates an environment that’s toxic to sperm. It may also keep the egg from attaching to the uterus.

Another option: Implanon, a matchstick-size rod that’s implanted under the skin of your arm to release progestin and lasts for up to three years. One downside: It often causes breakthrough bleeding, so you’d have to be willing to put up with that.

My husband got a vasectomy after our first child, but now we want to have more. Is it really permanent?

It can be reversed, but it’s pricey (from $6,800 to $13,000) and the success rate is only 30 to 40 percent. Another option to consider: A physician can use a needle to remove sperm from the testicles and then perform in vitro fertilization.

This is from WomensHealth.org and is a list of some of the options are available:

Intrauterine Devices or IUDs

An IUD is a small device shaped like a “T” that goes in your uterus. There are two types:

Copper IUD — The copper IUD goes by the brand name ParaGard. It releases a small amount of copper into the uterus, which prevents the sperm from reaching and fertilizing the egg. It fertilization does occur, the IUD keeps the fertilized egg from implanting in the lining of the uterus. A doctor needs to put in your copper IUD. It can stay in your uterus for 5 to 10 years.

Hormonal IUD — The hormonal IUD goes by the brand name Mirena. It is sometimes called an intrauterine system, or IUS. It releases progestin into the uterus, which keeps the ovaries from releasing an egg and causes the cervical mucus to thicken so sperm can’t reach the egg. It also affects the ability of a fertilized egg to successfully implant in the uterus. A doctor needs to put in a hormonal IUD. It can stay in your uterus for up to 5 years.

Implantable Rod

This is a matchstick-size, flexible rod that is put under the skin of the upper arm. It is often called by its brand name, Implanon. The rod releases a progestin, which causes changes in the lining of the uterus and the cervical mucus to keep the sperm from joining an egg. Less often, it stops the ovaries from releasing eggs. It is effective for up to 3 years.

Oral Contraceptives — Combined pill (“The pill”)

The pill contains the hormones estrogen and progestin. It is taken daily to keep the ovaries from releasing an egg. The pill also causes changes in the lining of the uterus and the cervical mucus to keep the sperm from joining the egg.

Some women prefer the “extended cycle” pills. These have 12 weeks of pills that contain hormones (active) and 1 week of pills that don’t contain hormones (inactive). While taking extended cycle pills, women only have their period three to four times a year.

Many types of oral contraceptives are available. Talk with your doctor about which is best for you.

Your doctor may advise you not to take the pill if you:

Are older than 35 and smoke

Have a history of blood clots

Have a history of breast, liver, or endometrial cancer

Antibiotics may reduce how well the pill works in some women. Talk to your doctor about a backup method of birth control if you need to take antibiotics.

Oral Contraceptives — Progestin-only pill (“Mini-pill”)

Unlike “the pill,” the mini-pill only has one hormone –– progestin. Taken daily, the mini-pill thickens cervical mucus, which keeps the sperm from joining the egg. Less often, it stops the ovaries from releasing an egg.

Mothers who breastfeed can use the mini-pill. It won’t affect their milk supply. The mini-pill is a good option for women who:

Can’t take estrogen

Are older than 35

Have a risk of blood clots

The mini-pill must be taken at the same time each day. A backup method of birth control is needed if you take the pill more than 3 hours late. Antibiotics may reduce how well the pill works in some women. Talk to your doctor about a backup method of birth control if you need to take antibiotics.

The Patch

Also called by its brand name, Ortho Evra, this skin patch is worn on the lower abdomen, buttocks, outer arm, or upper body. It releases the hormones progestin and estrogen into the bloodstream to stop the ovaries from releasing eggs in most women. It also thickens the cervical mucus, which keeps the sperm from joining with the egg. You put on a new patch once a week for 3 weeks. You don’t use a patch the fourth week in order to have a period.

Shot/Injection

The birth control shot often is called by its brand name Depo-Provera. With this method you get injections, or shots, of the hormone progestin in the buttocks or arm every 3 months. A new type is injected under the skin. The birth control shot stops the ovaries from releasing an egg in most women. It also causes changes in the cervix that keep the sperm from joining with the egg.

The shot should not be used more than 2 years in a row because it can cause a temporary loss of bone density. The loss increases the longer this method is used. The bone does start to grow after this method is stopped. But it may increase the risk of fracture and osteoporosis if used for a long time.

Vaginal Ring

This is a thin, flexible ring that releases the hormones progestin and estrogen. It works by stopping the ovaries from releasing eggs. It also thickens the cervical mucus, which keeps the sperm from joining the egg.

It is commonly called NuvaRing, its brand name. You squeeze the ring between your thumb and index finger and insert it into your vagina. You wear the ring for 3 weeks, take it out for the week that you have your period, and then put in a new ring.